Author: Rodrigo Arrangoiz MS, MD, FACS, FSSO

• Definition of nipple discharge:
  • Fluid that leaks from one or both nipples is called a nipple discharge:
    • Each breast has several (15 to 20) milk ducts:
      • A discharge can come from one or more of these ducts
• Nipple discharge accounts for approximately 2% to 10% of the symptoms that women report when they seek care at breast clinics:
  • Causing anxiety in patients because it can be a presenting sign of breast cancer:
    • However, it is usually benign in origin (papillomas and galactophore / mammary duct ectasia):
      • With a 5% to 21.3% risk of an underlying malignant lesion:
        • Mostly due to in situ carcinomas
• Nipple discharge can occur normally during the last weeks of pregnancy and after childbirth:
  • When breast milk is produced
• A nipple discharge can also be normal in women who are not pregnant or breastfeeding:
  • Especially during the reproductive years:
    • For example, in women, fondling, suckling, irritation from clothing, or sexual arousal can stimulate a nipple discharge, as can stress:
      • However, a nipple discharge in men is always abnormal
• A normal nipple discharge is usually:
  • A thin, cloudy, whitish, or almost clear fluid that is not sticky:
    • However, the discharge may be other colors, such as gray, green, yellow, or brown
  • During pregnancy or breastfeeding:
    • A normal discharge is sometimes slightly bloody
• If the discharge is considered to be physiologic on the basis of clinical information and characteristics of the nipple discharge:
  • No further imaging studies of the breast are warranted:
• Although approximately 80% to 90% of patients with pathologic nipple discharge have been reported to have benign conditions:
  • Breast imaging enables the localization of the breast abnormalities causing the pathologic nipple discharge:
    • Which helps minimize the number of operations and / or the extent of surgery
    • In addition, localizing the origin of pathologic nipple discharge enables percutaneous biopsy under imaging guidance:
      • Which allows clinicians to be more confident when deciding upon management and when choosing whether to perform minimally invasive percutaneous vacuum-assisted excision
• Abnormal discharges vary in appearance depending on the cause:
  • An abnormal discharge may be accompanied by other abnormalities:
    • Such as dimpled skin, swelling, redness, crusting, sores, and a retracted nipple:
      • A nipple is retracted if it pulls inward and does not return to its normal position when it is stimulated
  • If a discharge from only one breast occurs on its own (without any stimulation of the nipple):
    • It is considered abnormal
• Causes:
  • Several disorders can cause an abnormal discharge:
    • A discharge from one milk duct or from one breast:
      • Is likely to be caused by a problem with that breast:
        • Such as a noncancerous (benign) or cancerous breast tumor
    • A discharge from both breasts or from several milk ducts in one breast is more likely to be caused by a problem outside the breast:
      • Such as a hormonal disorder or use of certain drugs
• Common causes of a nipple discharge:
  • Usually, the cause is a benign disorder of the milk ducts, such as the following:
    • A benign tumor in a milk duct (intra ductal papilloma):
      • Intra ductal papilloma is the most common cause
      • It is also the most common cause of a bloody nipple discharge when there is no lump in the breast
    • Dilated milk ducts (mammary duct ectasia)
    • Fibrocystic changes:
      • Including pain, cysts, and general lumpiness
    • A breast infection or abscess
    • Less common causes of a nipple discharge:
      • Certain disorders stimulate the production of breast milk in women who are not pregnant or breastfeeding:
        • In most of these disorders, the level of prolactin (a hormone that stimulates production of breast milk) is elevated:
          • Taking certain drugs can have the same effect
      • Cancer causes fewer than 10% of cases:
        • Nipple discharge is a cause for concern when it:
          • Occurs without the nipple’s being squeezed or stimulated by other means (when it occurs spontaneously)
          • Occurs in women aged 40 or older
          • Comes from only one breast
          • Is bloody or pink
          • Is accompanied by a lump that can be felt
          • Occurs in a boy or man
• Preferred examination:
  • Mammography or digital breast tomosynthesis (DBT):
    • Is the first-line study for a pathologic discharge in most patients:
      • Mammography is limited:
        • Because of its poor sensitivity of 20% to 25%
        • A negative mammogram in the context of nipple discharge:
          • Does not therefore exclude any underlying disease:
  • Ultrasound is performed immediately after mammography even if the mammogram is normal
• According to the American College of Radiology (ACR) Appropriateness Criteria:
  • For women 30 to 39 years of age:
    • Either mammography or ultrasonography may be used as the initial examination
  • For women aged 30 years or younger:
    • Ultrasound should be the initial examination:
      • With mammography / DBT added when ultrasound shows suspicious findings or if the patient is predisposed to developing breast cancer
  • For men aged 25 years or older:
    • Mammography / DBT should be, performed initially:
      • With ultrasound added as indicated, given the high incidence of breast cancer in men with pathologic nipple discharge
  • Although MRI and ductography (galactography) are not usually appropriate as initial examinations:
    • Each may be useful when the initial standard imaging evaluation is negative

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• Criteria which allow safe observation of the suspected fibroadenoma:
  • Age less than 35 years
  • Physical examination demonstrating a mobile and well-circumscribed mass
  • Size: 2.5 cm
  • And if present:
    • A biopsy definitive for fibroadenoma

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Dual anti-CTLA-4 and anti-PD-1 blockade with the combination of ipilimumab (Yervoy) with nivolumab (Opdivo) induced an objective response rate (ORR) of 12% as treatment of patients with thyroid cancer, according to findings for the thyroid cancer cohort in the phase 2 SWOG S1609 Dual Anti-CTLA-4 and Anti-PD-1 blockade in Rare Tumors (DART) clinical trial (NCT02834013).¹

These 2 agents have proven effective in many different tumor histologies, including subpopulations of melanoma and lung cancer, but their efficacy as treatment of rare tumors has not been determined. The study, which was presented in a poster during the 2020 Society for Immunotherapy of Cancer (SITC) Annual Meeting, is a prospective, open-label, multicenter trial aimed to explore the efficacy of this combination in rare cancers.

Ipilimumab was administered intravenously (IV) at 1 mg/kg every 6 weeks plus nivolumab 240 mg IV every 2 weeks. The thyroid cancer cohort included 17 patients who were eligible and received therapy out of 21 patients who registered to this cohort. The primary end point of the study is ORR, and secondary end points include progression-free survival (PFS), overall survival (OS), stabled disease (SD) >6 months, and toxicity.

The median age of patients in the thyroid cohort was 59 years (range, 33-78), and 10 (59%) patients were male. The most common thyroid cancer subtype was papillary in 47% of patients, while other subtypes in the cohort included medullary thyroid cancer (MTC; 24%), anaplastic thyroid cancer (ATC; 24%), and Hurthle cell histology (6%).

In terms of ORR, 2 patients had a confirmed partial response (12%), which included 1 patient with PTC and 1 with ATC. One of the 4 patients with ATC had a response that lasted more than 2 years (25%). SD lasted for more than 6 months in 6 patients (35%), while 2 (12%) had SD for less than 6 months. The clinical benefit rate, which included all PRs and SD over 6 months, was 59%.

One patient with PTC who withdrew early due to toxicities, including neuropathic pain and arthralgias, had SD for more than 1 year but was not included in the response assessment.

The median PFS was 9.5 months (95% CI, 4.99-∞), and the median OS was not reached. The 6-month PFS rate was 58% (95% CI, 39-88), and the 6-month OS rate was 88% (95% CI< 74%-100%).

Overall, 94.1% of patients experienced adverse events (AEs), and 52.9% had grade 3-5 AEs. The most common AEs of any grade included fatigue in 41.2%, elevated lipase (29.4%), and acute kidney injury, diarrhea, generalized muscle weakness, anorexia, pruritis, nausea and alanine aminotransferase elevation in 21.1% each.

The most common immune-mediated AES included acute kidney injury and elevated lipase, which occurred in 29.4% of patients each. While enrolled in the study, 1 patient died.

Immunotherapy and monoclonal antibodies, such as nivolumab and ipilimumab, are suspected to assist the body’s immune system in order to attack the cancer, and these therapies may also interfere with the ability of tumor cells to grow and spread.

This combination has demonstrated its benefit with FDA approval as treatment of patients with metastatic or recurrent non–small cell lung cancer whose tumors express PD-L1 ≥1% and who do not harbor an EGFR or ALK tumor aberration. This approval was granted in May 2020 based on positive findings from the phase 3 CheckMate 227 study, which demonstrated a significant improvement in OS over chemotherapy alone.²

More recently in October 2020, the FDA also granted approval to this combination for the frontline treatment of adult patients with unresectable malignant pleural mesothelioma, which marked the first and only immunotherapy regimen indicated for the treatment of untreated, unresectable disease.³

_References

_{1. Chae YK, Othus M, Patel SP, et al. A phase ii basket trial of dual anti-cdla-4 and anti-pd-1 blockade in rare tumors (DART) SWOG 1609: the thyroid tumor cohort. Poster presented at: SITC Annual Meeting. November 11-14, 2020; Virtual.}

_{2. FDA approves nivolumab plus ipilimumab for first-line mNSCLC (PD-L1 tumor expression ≥1%) BMS [news release]. FDA. May 15, 2020. Accessed November 12, 2020. https://bit.ly/3cwvlo2​} 

_{3. U.S. Food and Drug Administration Approves Opdivo® (nivolumab) + Yervoy® (ipilimumab) as the First and Only Immunotherapy Treatment for Previously Untreated Unresectable Malignant Pleural Mesothelioma. News release. Bristol Myers Squibb. October 2, 2020. Accessed November 12, 2020. https://bwnews.pr/}

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• Previously, there was no consensus on the optimal time intervals for imaging evaluation of patients following breast-conservation surgery:
  • Many practices performed 6-month interval mammography of the treated breast for a variable number of years in an effort to monitor post-procedure changes

• The usefulness of short-term follow-up mammography in women undergoing breast conservation has been challenged:
  • Local recurrence in the ipsilateral breast following breast conservation and radiotherapy occurs at:
    • An estimated rate of:
      • 1% in the first year
      • 3% to 9% at 5 years
      • 14% to 20% at 20 years
  • Retrospective studies have verified that the yield from a 6-month follow-up mammogram on the affected side is:
    • Low (≤ 1%)
• Therefore, the ACR and ASCO recommendations are:
  • To perform a bilateral mammogram at 12 months from the initial mammogram:
    • Which should be at least 6 months following completion of radiotherapy:
      • And should include a diagnostic mammogram on the affected side and a screening mammogram on the nontreated side
  • Bilateral annual mammography is recommended thereafter
• Elimination of the 6-month and 18-month interval diagnostic mammograms after breast conservation:
  • Should spare women unnecessary anxiety, discomfort, and inconvenience while lowering costs and improving efficiency

• References:
  • https://www.asco.org/research-guidelines/quality-guidelines/guidelines/breast-cancer#/9821 Accessed July 20, 2020
  • Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 2018;15(3 Pt A):408-414.
  • Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(7):961-965.

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• Accelerated partial breast irradiation includes multiple techniques such as: 
  • Interstitial brachytherapy
  • Applicator brachytherapy
  • External beam radiation therapy
• The Groupe Européen de Curie thérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) trial:
  • Randomized 1184 patients with: 
    • Low-risk invasive carcinoma or ductal carcinoma in situ (DCIS) treated with breast-conserving surgery to either whole-breast irradiation (WBI) or APBI using multi catheter brachytherapy: 
      • The cumulative incidence of local recurrence at 5 years was: 
        • 1.44% with APBI
        • 0.92% with WBI
• The Florence trial:
  • Randomized 520 patients to either WBI or APBI with intensity-modulated radiation therapy:
    • With a mean follow-up of 5 years: 
      • The rate of local recurrence was: 
        • 1.5% in both arms
• The American Society of Breast Surgeons’ Mammo Site Registry found: 
  • 5-year rates of local recurrence were less than 4%
• An older randomized trial from Hungary using interstitial APBI and electrons: 
  • 5-year local recurrence rate of 4.7%
• It is important to recognize that these outcomes are likely due to: 
  • The highly selected, low-risk patient populations included in many of the APBI trials as evidenced by the tables / guidelines:
    • Patients tend to be: 
      • Postmenopausal
      • Tumors less than 3 cm, without DCIS
      • Node negative
      • ER-positive

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• The TP53 gene:
  • Is a key tumor-suppressor gene:
    • That acts as a checkpoint control for DNA damage
  • Due to its critical role in controlling cellular damage:
    • A TP53 germline mutation predisposes patients to multiple malignancies, including:
      • Breast cancer and soft tissue sarcomas
• The associated familial syndrome was first observed in 1969 and is known as the Li-Fraumeni syndrome:
  • The penetrance of breast cancer related to TP53 mutations is higher than seen in the more common BRCA 1 or BRCA 2 mutations:
    • With a cumulative incidence reported for TP53 of:
      • 85% by age 60.
    • TP53-associated breast cancers:
      • Present at an early age:
        • Median age of diagnosis is 34
      • The majority are:
        • Hormone receptor positive and / or HER-2 positive
    • Due to this high penetrance and associated increased risk for a secondary breast cancer:
      • Bilateral prophylactic mastectomy is recommended:
        • For management of an early-stage breast cancer in patients with a mutation in TP53
      • This is especially true in younger women:
        • As contralateral breast cancer risk inversely correlates with the patient’s age
      • The recommendation for mastectomy is further supported by the concern regarding radiation use in this patient population already at increased risk for soft tissue sarcomas:
        • Radiation should be used with extreme caution and careful consideration of the risk / benefit
  • For patients presenting with a known TP53 germline mutation and without a diagnosis of breast cancer:
    • NCCN guidelines recommend:
      • Annual breast MRI at 20 to 29 years
      • Annual MRI and mammography at 30 to 75 years for high-risk breast cancer screening
      • Consideration of prophylactic risk-reducing mastectomy should be made in context of the age of presentation:
        • As breast cancer risk increases significantly after the second decade of lifein these patients:
          • Bilateral mastectomy should be considered:
            • Starting at age 20
        • The risk of breast cancer peaks at age 40 to 45 and then decreases:
          • Therefore bilateral mastectomy offers significantly less benefit in women over 60 years of age

• References:
• Mai PL, Best AF, Peters JA, DeCastro RM, Khincha PP, Loud JT, Bremer RC, Rosenberg PS, Savage SA Risks of first and subsequent cancers among TP53 mutation carriers in the National Cancer Institute Li-Fraumeni syndrome cohort. Cancer. 2016 Dec 1; 122(23):3673-3681.
• Masciari S, Dillon DA et al. Breast cancer phenotype in women with TP53 germline mutations: a Li Fraumeni syndrome consortium effort. Breast Cancer Res Treat. 2012;133(3):1125–1130.
• Schon, K, Tischkowitz, M. Clinical implications of germline mutations in breast cancer: TP53 Breast Cancer Res Treat. 2018; 167(2): 417–423.
• National Comprehensive Cancer Network (2014) Genetic/familial high risk assessment: breast and ovarian. Li Fraumeni syndrome management. NCCN Clinical Practice Guidelines in Oncology. Version 1.2018.

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• Women who receive thoracic (i.e., mantle) radiation prior to age 30:
  • Are at increased risk of breast cancer:
    • Although standardized incidence ratios vary from 13 to 55:
      • Based on:
        • Patient factors
        • Disease factors
        • Treatment factors
  • In the Late Effects Study Group trial:
    • The relative risk of breast cancer varied by follow-up interval:
      • And was greatest at 15 to 19 years after radiation exposure
• Screening guidelines for those under age 25 include:
  • An annual clinical exam beginning 10 years after the radiation exposure
• Screening guidelines for those over age 25 include:
  • An annual clinical exam beginning 8 to 10 years after the radiation exposure:
    • With the addition of:
      • Annual screening mammogram for patients ≥ age 30
      • Annual MRI is recommended for patients ≥ age 25
• Recent studies reporting the persistence of gadolinium deposits in the brain:
  • Following serial contrast MRI scans:
    • Have led to a related FDA safety alert:
      • However, deposition is associated with only some gadolinium based contrast agents, and there is no clinical data that this results in detrimental long-term cognitive effects
• There is currently no evidence that:
  •  Biannual MRI is more valuable than annual MRI for screening

• References:
  • Henderson TO, Amsterdam A, Bhatia S, Hudson MM, Meadows AT, Neglia JP, et al. Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer. Ann Intern Med. 2010;152(7):444-454.
  • van Leeuwen FE, Klokman WJ, Stovall M, Dahler EC, van’t Veer MB, Noordijk EM, et al. Roles of radiation dose, chemotherapy, and hormonal factors in breast cancer following Hodgkin’s disease. J Natl Cancer Inst. 2003;95(13):971-980.
  • National Comprehensive Cancer Network. Breast Cancer Screening and Diagnosis, Version 1.2019. https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf. Accessed February 23, 2020.
  • Ramalho J, Ramalho M, Jay M, Burke LM, Semelka RC. Gadolinium toxicity and treatment. Magn Reson Imaging. 2016;34(10):1394-1398.
  • Stojanov D, Aracki-Trenkic A, Benedeto-Stojanov D. Gadolinium deposition within the dentate nucleus and globus pallidus after repeated administrations of gadolinium-based contrast agents-current status. Neuroradiology. 2016;58(5):433-441.
  • Olchowy C, Cebulski K, Lasecki M, et al. The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity – A systematic review. PLoS One. 2017;12(2):e0171704.

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• Two randomized clinical trials were initiated and terminated early:
  • Due to an increase in breast cancer events:
    • In patients in the hormone replacement therapy (HRT) arm:
      • With a personal history of breast cancer
  • The HABITS (Hormonal Replacement Therapy after Breast Cancer – Is It Safe?) trial:
    • Randomized 442 patients:
      • With a personal history of breast cancer to HRT with estradiol with or without progesterone (based on the presence of a uterus) vs. nonhormonal symptom management:
        • More women in the HRT arm than the non-HRT arm had hormone receptor-positive breast cancer:
          • 62.3% vs 54.5%:
            • Approximately half of patients in each group had taken HRT before their diagnosis of breast cancer
      • At median follow-up of 4 years:
        • New breast cancer events occurred twice as frequently in the HRT group (hazard ratio [HR] 2.4) compared to the nonhormonal symptom management group
  • A similar trial in Stockholm:
    • Found no difference in breast cancer recurrence:
      • In patients randomized to HRT vs. no HRT at 11 years of follow-up:
        • But reported an increased risk of contralateral breast cancer in those receiving HRT (HR 3.6, p=0.013)
• Estrogen alone can be used to reduce symptoms:
  • For postmenopausal women:
    • Without a personal history of breast cancer
    • Who have had a hysterectomy
  • Was associated with a nonsignificant lower risk of breast cancer in the Women’s Health Initiative trial at 13 years of follow-up (HR 0.79):
    • However, the WHI cohort did not include women with a personal history of breast cancer, and therefore these data cannot be extrapolated to this population
• Expert guidelines recommend:
  • The use of topical low-dose vaginal estrogen therapy for women with bothersome genitourinary symptoms and contraindications to the use of systemic HRT:
    • This is a reasonable strategy in breast cancer survivors:
      • Due to the local nature of vaginal estrogen and its low systemic absorption

• References
  • Holmberg L, Iversen OE, Rudenstam CM, Hammar M, Kumpulainen E, Jaskiewicz J, et al. Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst. 2008;100(7):475-482.
  • Fahlén M, Fornander T, Johansson H, Johansson U, Rutqvist LE, Wilking N, et al. Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial. Eur J Cancer. 2013;49(1):52-59.
  • Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL, et al. Menopausal hormone therapy and health outcomes during the intervention and extended post-stopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353-1368.
  • The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24(7):728-753.

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• Magnetic resonance imaging (MRI) of the breast uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the structures within the breast. It is primarily used as a supplemental tool to breast screening with mammography or ultrasound. It may be used to screen women at high risk for breast cancer, evaluate the extent of cancer following diagnosis, or further evaluate abnormalities seen on mammography. Breast MRI does not use ionizing radiation, and it is the best method for determining whether silicone breast implants have ruptured.
• The magnetic field is not harmful, but it may cause some medical devices to malfunction. Most orthopedic implants pose no risk, but you should always tell the technologist if you have any devices or metal in your body. Guidelines about eating and drinking before your exam vary between facilities. Unless you are told otherwise, take your regular medications as usual. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. If you have claustrophobia or anxiety, you may want to ask your doctor for a mild sedative prior to the exam. 

What is MRI of the Breast?

• Magnetic resonance imaging (MRI) is a noninvasive test used to diagnose medical conditions.
• MRI uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of internal body structures. MRI does not use radiation (x-rays).
• Detailed MR images allow doctors to examine the body and detect disease. The images can be reviewed on a computer monitor. They may also be sent electronically, printed or copied to a CD, or uploaded to a digital cloud server.
• MRI of the breast offers valuable information about many breast conditions that cannot be obtained by other imaging modalities, such as mammography or ultrasound.

What are some common uses of the procedure?

• MRI of the breast is not a replacement for mammography or ultrasound imaging but rather a supplemental tool that has many important uses, including:
• Screening in women at high risk for breast cancer:
  • For women at high risk for breast cancer, typically because of a strong family history, MRI may be an appropriate tool to screen for breast cancer. A strong family history is usually a mother or sister who has had breast cancer before age 50. It can also be aunts or cousins, including those on your father’s side. Relatives who have had ovarian cancer also increase your risk. Your radiologist or primary care doctor can look at your family history and determine if screening MRI may be appropriate for you. Depending on your family history, genetic counseling may also be recommended.
    
• Determining the extent of cancer after a new diagnosis of breast cancer :
  • After being diagnosed with breast cancer, a breast MRI may be performed to determine: 
    • how large the cancer is and whether it involves the underlying muscle.
    • if there are other cancers in the same breast and whether there is an unsuspected cancer in the opposite breast.
    • if there are any abnormally large lymph nodes in the armpit, which can be a sign the cancer has spread to that site.
      
• Further evaluating hard-to-assess abnormalities seen on mammography:
  • Sometimes an abnormality seen on a mammogram cannot be adequately evaluated by additional mammography and ultrasound alone. In these rare cases, MRI can be used to definitively determine if the abnormality needs biopsy or can safely be left alone.
    
• Evaluating lumpectomy sites in the years following breast cancer treatment:
  • Scarring and recurrent cancer can look identical on mammography and ultrasound. If a change in a lumpectomy scar is detected by either mammography or a physical exam, MRI can help determine whether the change is normal maturation of the scar or a recurrence of the cancer.
    
• Following chemotherapy treatment in patients receiving neoadjuvant chemotherapy:
  • In some cases, breast cancer will be treated with chemotherapy before it has been removed by surgery. This is called neoadjuvant chemotherapy. In these cases, MRI is often used to monitor how well the chemotherapy is working and to reevaluate the amount of tumor still present before the surgery is performed.
    
• Evaluating breast implants:
  • MRI is the best test for determining whether silicone implants have ruptured.

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A mammogram is an X-ray picture of the breast. Doctors use a mammogram to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt.

How is a mammogram done?

You will stand in front of a special X-ray machine. A technologist will place your breast on a plastic plate. Another plate will firmly press your breast from above. The plates will flatten the breast, holding it still while the X-ray is being taken. You will feel some pressure. The steps are repeated to make a side view of the breast. The other breast will be X-rayed in the same way. You will then wait while the technologist checks the four X-rays to make sure the pictures do not need to be re-done. Keep in mind that the technologist cannot tell you the results of your mammogram. Each woman’s mammogram may look a little different because all breasts are a little different.

What does having a mammogram feel like?

Having a mammogram is uncomfortable for most women. Some women find it painful. A mammogram takes only a few moments, though, and the discomfort is over soon. What you feel depends on the skill of the technologist, the size of your breasts, and how much they need to be pressed. Your breasts may be more sensitive if you are about to get or have your period. A doctor with special training, called a radiologist, will read the mammogram. He or she will look at the X-ray for early signs of breast cancer or other problems.Tips for Getting a Mammogram

• Try not to have your mammogram the week before you get your period or during your period. Your breasts may be tender or swollen then.
• On the day of your mammogram, don’t wear deodorant, perfume, or powder. These products can show up as white spots on the X-ray.
• Some women prefer to wear a top with a skirt or pants, instead of a dress. You will need to undress from your waist up for the mammogram.

When will I get the results of my mammogram?

You will usually get the results within a few weeks, although it depends on the facility. A radiologist reads your mammogram and then reports the results to you and your doctor. If there is a concern, you will hear from the mammography facility earlier. Contact your health care provider or the mammography facility if you do not receive a report of your results within 30 days.

An example of a normal mammogram. Each woman’s mammogram may look a little different because all breasts are a little different.

What happens if my mammogram is normal?

Continue to get mammograms according to recommended time intervals. Mammograms work best when they can be compared with previous ones. This allows the radiologist to compare them to look for changes in your breasts.

What happens if my mammogram is abnormal?

An abnormal mammogram does not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. You may also be referred to a breast specialist or a surgeon. It does not necessarily mean you have cancer or need surgery. These doctors are experts in diagnosing breast problems. Doctors will do follow-up tests to diagnose breast cancer or to find that there is no cancer.

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